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Biomedical subjects

C Höger

Publications and source records attributed to C Höger.

17 recordsLinked to original sources
PubMed2002

Predictors of length of stay in inpatient child and adolescent psychiatry: failure to validate an evidence-based model.

OBJECTIVE: To test if predictors of length of stay are based on empirical evidence. METHOD: 1001 regularly terminated treatment episodes from 13 child and adolescent psychiatric hospitals were analysed. In order to cross- validate the results, the sample was randomly divided into a definition sample (n = 500) and a validation sample (n = 501). The variables in the definition sample were screened statistically for their suitability as predictors of logarithmic length of stay (logLOS). Variables shown to be significant and uncorrelated were entered into multifactor analyses of variance in order to generate the model with the largest amount of explained variance of logLOS. Subsequently the results were tested against the validation sample. RESULTS: In the definition sample we found the three predictor variables admission as crisis intervention, out of home dispositions and psychoanalytic therapy which could explain 23.7 % of the variance of logLOS. Unfortunately, this could not be replicated in the validation sample as a model. CONCLUSION: Simple models of prediction of LOS in the field of child and adolescent psychiatry cannot be reliably based on empirical evidence. The main consequence is that fixed disorder-related reimbursement systems do not seem justified.

Adjustment Disorders↗
PubMed2001

[When should inpatient child and adolescent psychiatric treatment be terminated?].

OBJECTIVES: As up to now no thorough empirical investigation of the length of stay during inpatient treatment exists, the criteria for the decision to terminate inpatient treatment were studied. METHODS: The opinions of experts in child psychiatry were collected by means of a three-part questionnaire that included a general section together with questions concerning the respective profession group of each expert, a structured section, and a section with open questions. 200 questionnaires were mailed to members of different professional groups at all hospitals for child and adolescent psychiatry in Lower Saxony and Bremen. 112 questionnaires were returned. Data were evaluated descriptively and by means of analyses of variance to determine whether the assessment patterns differ among the various groups. RESULTS: Complex criteria were found by attributing answers to both the structural and the open questions, which included patient-related aspects (particularly the course of symptoms and the child's/adolescent's development of competence), conditions in the family, administrative influences (aftercare and post-discharge placement), problems in the therapeutic setting, aspects of group dynamics between patients and staff, as well as problems involving motivation and compliance. The decision patterns in the professional groups did not differ. CONCLUSION: To reduce the length of inpatient treatment to criteria in accordance with DRGs would be to overlook essential professional aspects of a qualified decision process and thus constitute a misleading strategy with regard to effectiveness and efficiency. The use of the criteria found here as components of a quality management process might be a better way to achieve this goal.

Adolescent↗
PubMed2000

[Psychotherapeutic and psychosocial therapy in general practice. Results of demonstration project on quality management in psychosocial primary care].

Since 1987, psychosocial primary care (PPC) provided by General Practitioners, are reimbursed by German health insurances. The aim of the psychosocial primary care is to improve recognition and treatment of mental disorders in the primary care sector. As a part of a eight-center national demonstration program on quality management in the outpatient services, General Practitioners (n = 191) from 5 regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial strain were documented. Differences between psychosocial strain, treatment and outcome were determined by analyses of variance. Men and patients beyond the age of 65 were underrepresented. Psychosocial treatments were offered more often to those patients, who had the highest level of anxiety and depression. Patients with physical illness, with pain and without psychological attribution to the illness belief were offered less psychosocial interventions and reached a worse outcome. The study outcome helps to improve training programs as to recognition and treatment of psychosocial problems in primary care. Male and generally elderly patients with somatic symptoms and lack of psychological attribution need a special psychosocial intervention to improve the outcome.

Adult↗
PubMed2000

[Primary psychosomatic management in general practice. Results of a German nationwide demonstration project of quality assurance].

In the frame of a national demonstration program, psychosocial care of patients with psychological and psychosomatic problems were assessed. General practitioners (n = 191) from six regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial symptoms were documented. Anxiety (62%), depression (51%) and marital/family conflicts (44%) were the most frequent symptoms. Somatic treatment and psychosocial intervention were offered equally. Patients with psychosocial treatment achieved better results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-orientated case conferences, consultation services and collaborative groups.

Combined Modality Therapy↗
PubMed1999

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

OBJECTIVE: Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. METHOD: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. RESULTS: Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. CONCLUSIONS: These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Adolescent↗
PubMed1999

[Pediatric quality circles moderated by child psychiatrists--a suitable quality assurance measure in basic psychosomatic care?].

The important role of pediatricians in private practice for the care of psychologically noticeable children makes it seem necessary to implement quality assurance measures. As part of an integrated project for quality assurance in psychosomatic basic care the pediatricians in the medical care district Göttingen were offered two quality circles for two years which in contrast to the original concept were conducted by child psychiatrists. The evaluation of this offer by the participating pediatricians after one year (n = 16) and after the end (n = 15) yielded very positive results regarding the structural characteristics of the quality circles (such as length of sessions, subject selection, moderation, working atmosphere) and also the general usefulness of such a quality assurance measure. The increase in competence regarding practical skills (diagnostics, treatment in the own practice, referee indication, forming the physician-patient relationship) however, was evaluated as being less pronounced. The attractiveness of a quality circle modified by continuously integrating a child psychiatrist/psychotherapist was confirmed by the results of a national survey. In another survey the participating pediatricians documented cases where they suspected psychological problems before the quality circles began and after the first year. Sensitivity and specificity of the pediatricians' assessments increased at the second evaluation point which is a sign for an increased diagnostic competency of pediatricians.

Child↗
PubMed1998

[Variability of inpatient child and adolescent psychiatry--results of a multicenter documentation].

OBJECTIVE: For the first time in the German-speaking countries a complete evaluation of all 1236 inpatient treatment episodes within one year of investigation was carried out. METHOD: Case-related patient documentation at all of the 13 clinics for child and adolescent psychiatry in Lower Saxony and Bremen were evaluated. RESULTS: Data from all clinics agreed widely on the following: 1. the divergent family structures of the young patients compared to those of the general public, 2. a high degree of individual psychotherapy, and 3. the inclusion of the patient's social circumstances in the individual psychotherapy. Nonetheless, results for most of the variables assessed differed strongly. Inpatient child and adolescent psychiatric care thus seems to vary highly among clinics within the same epidemiological area. CONCLUSIONS: Hence, even when the reported number of episodes is high, no general conclusions on inpatient child and juvenile psychiatric treatment can be drawn on the basis of admissions data for individual clinics. Interinstitutional comparisons must be made on the assumption that there is no prototype clinic for child and adolescent psychiatry. Additional general conclusions include the lack of a disorder-specific approach to treatment. The entry of a large number of patients into foster or state homes following inpatient treatment reflects the impact upon them of abnormal psychosocial circumstances, as well as their decreased psychosocial adaption.

Adolescent↗
PubMed1995

[Who goes into treatment? Modifying factors on utilization behavior in psychological problems of children and adolescents].

Only about 20% of all children and youths with mental disorders are treated by specific institutions. Using a literature survey the author will look into connections with this fact. Aside from several child, family, and institution related characteristics such as kind and severity of the disturbance or degree of psycho-social stress in the family the parents' attitude towards expert help and the subjective need to be helped seem to be important factors which influence utilizing behavior. The complexity of these dimensions deem it appropriate to use process orientated theoretical concepts and multivariate statistical methods to explain them. The subjective component is illustrated by the author's own pilot study. In an exploratory approach parents' ideas and reflections regarding expert help were collected and evaluated with content analytic methods. Aside from other cognitive patterns it seems that type and degree of the problems are less important decision criteria than the family's coping abilities. In conclusion the author makes some suggestions on how the entitlement to be helped can be utilized better.

Adolescent↗
PubMed1995

[Documentation in child and adolescent psychiatry: experiences from a multicenter study].

Reasons for the need for a coordinated multi-centered documentation for quality safeguarding are given. Based upon experiences with patient documentation, where 13 child and youth psychiatries in the German states Lower Saxony and Bremen participated for one year, problems with a documentation system are shown and discussed. In conclusion recommendations are given for carrying out such studies, which will become more important in the framework of quality safeguarding in child and youth psychiatries.

Adolescent↗
PubMed1994

[Systemic approaches in ambulatory child and adolescent psychiatry].

Systemic therapy is considered a method which is based upon the constructivist development of systemic theories. The effectiveness and efficiency thereof is discussed on the basis of one's own evaluation of the therapy with a reflecting team. Further more conceptional differences are determined between the two social systems child psychiatry and systemic therapy. These preliminaries are the foundation upon which we are able to discuss the status of systemic therapy within child psychiatry in theory as well as in practice.

Adolescent↗
PubMed1994

[Who benefits from systemic therapy with a reflecting team?].

In an evaluation study we investigated the effectiveness of the reflecting team approach compared to eclectic child psychiatric treatment in an outpatient setting and the indications for each type of treatment. The relationship between treatment outcome and diagnostic data obtained with the Multi-axial Classification Scheme was examined in 22 families treated with the reflecting team approach and in a second group of families matched on all important sociodemographic and diagnostic variables but receiving eclectic treatment. No difference was found between the two groups regarding symptom improvement or changes in family functioning. Regarding satisfaction with treatment, the reflecting team approach was superior to the eclectic modality. In the reflecting team group parental mental disorder and inadequate intra-familial communication (according to the new fifth axis of the Multi-axial Classification Scheme) had a negative effect on outcome.

Adolescent↗
PubMed1992

[Children with psychiatric disorders examined by established pediatricians].

OBJECTIVE: Studies concerning children with psychological disorders presented in the paediatric practice are rare. We therefore investigated rates of attendance and rates of referral to other specialists from theses practices. METHOD: The data were collected by the paediatricians and recorded according to a list of psychosocial symptoms. Frequencies were compared with results of a similar study concerning general practitioners. The chi-square seemed to be appropriate as test of significance. RESULTS: 18 paediatricians were included in the study. 8.3% of children seen by these professionals were thought to show signs of psychological deviance. The accompanying physical disorders hereby were the more prominent presenting symptoms. Only in 1.3% of the cases were psychological disorders the sole reason for the visit. In 30% of the cases were psychological problems a follow up referral to another institution was recommended. Rates of attendance and of follow-up referral were more frequent in rural practices than in practices of a university town. In general practices, 20.3% of children were noted as psychologically disturbed. CONCLUSIONS: The study reveals the important role played by paediatric practices in the mental health care, especially in rural regions. The low rate of psychological disorders as the only reason for attending a paediatric practice indicates that there may be an attendance pattern in which physical symptoms are initially used as a vehicle for subsequently presenting psychological disturbance.

Adolescent↗
PubMed1975

[Developmental neurological examinations in preparatory school children (author's transl)].

302 primarily healthy preparatory school children aged from 4-6 years were examined neurologically, using a slightly modified Touwen-Prechtl examination scheme. It was possible to make statistically confirmed statements on the individual tests of neurological function for a German kindergarten population. To develop a short (screening) test representative of the entire nervous system would be very difficult indeed. We hope, however, by means of rational data reduction, to be able to find a compromise between the complexity of the nervous system and the necessities of practice.

Age Factors↗